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Aetna timely filing for 20213/23/2023 ![]() ![]() However, for urgent care claims, a health care professional with knowledge of your medical condition may act as your authorized representative without your consent. ![]() Parties acting as your representative, such as medical providers, must include a copy of your specific written consent with the review request. Note: You are the only person who has a right to file a disputed claim with OPM. Note: If you want OPM to review more than one claim, you must clearly identify which documents apply to which claim. Please note that by providing your email address, you may receive OPM’s decision more quickly. Your email address, if you would like to receive OPM’s decision via email.Your daytime phone number and the best time to call.Copies of all letters we sent to you about the claim.Copies of all letters you sent to us about the claim.Copies of documents that support your claim, such as physicians’ letters, operative reports, bills, medical records, and explanation of benefits (EOB) forms.A statement about why you believe our decision was wrong, based on specific benefit provisions in this brochure.Write to OPM at: United States Office of Personnel Management, Healthcare and Insurance, Federal Employee Insurance Operations, Health InsuraE Street, NW, Washington, DC 20415-3620. 120 days after we asked for additional information.120 days after you first wrote to us, if we did not answer that request in some way within 30 days, or.90 days after the date of our letter upholding our initial decision, or.If you do not agree with our decision, you may ask OPM to review it. We will base our decision on the information we already have. If we do not receive the information within 60 days we will decide within 30 days of the date the information was due. You or your provider must send the information within 60 days of our request. Ask you or your provider for more information.Write to you and maintain our denial, or. ![]() In the case of a post-service claim, we have 30 days from the date we receive your request to: You may respond to that new evidence or rationale at the OPM review stage described in Step 4. However, our failure to provide you with new evidence or rationale in sufficient time to allow you to timely respond shall not invalidate our decision on reconsideration. We will provide you with this information sufficiently in advance of the date that we are required to provide you with our reconsideration decision to allow you a reasonable opportunity to respond to us before that date.
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